Ageing and Frailty

Question 1

What is the main factor driving the compression of mortality?

Answer 1

Social engineering (e.g. better housing and sanitation, clean water, nutrition) not medical interventions (although some have contributed, e.g. immunisations, improved maternal health)

Question 2

What is going to be one of the challenges to developing countries in light of their rapid increase in the average lifespan?

Answer 2

Increased burden on social programs

Question 3

What is the importance of compression of morbidity?

Answer 3

When lengthening the average lifespan, we want also to compress morbidity to avoid extending number of years lived with disease and disability

Question 4

Define cellular senescence. How does it differ from apoptosis?

Answer 4

The phenomenon where cells lose the ability to divide; both senescence and apoptosis can occur in response to DNA damage, but apoptosis occurs where the damage is irreversible

Question 5

What is organismal senescence?

Answer 5

The ageing of whole organisms

Question 6

What is frailty?

Answer 6

A distinct clinical syndrome associated with a low-grade chronic activation of the immune system and abnormalities of the endocrine and coagulation systems, conferring high risk for adverse health outcomes

Question 7

Which biomarkers are used to assess frailty?

Answer 7

2-4x increase in cytokines compared to those in infective or inflammatory states, particularly:
CRP
IL-6
TNF-a

Question 8

What is the difference between high levels of CRP, IL-6 and TNF-a in terms of their prognosis?

Answer 8

No clear link between CRP and mortality
High IL-6 associated with mortality, and decreased muscle mass and strength
TNF-a associated with mortality

Question 9

What is sarcopenia?

Answer 9

The ageing of skeletal muscle

Question 10

List 5 factors contributing to sarcopenia

Answer 10

Altered CNS and PNS innervation (loss of anterior horn cells and ventral root fibres)
Altered hormonal status (decreased GH, IGF-1, oestrogen and testosterone)
Inflammatory effects (increased IL-1 and IL-6 receptor antagonist)
Altered caloric and protein intake
Disuse

Question 11

When does decline in muscle mass begin? When does it become substantial?

Answer 11

Decline begins in 40s

Becomes substantial in 60s

Question 12

Which muscle fibres are preferentially lost? What kind of movements are these fibres responsible for?

Answer 12

Type 2 (fast twitch)
Responsible for fine, precise, rapid movement

Question 13

Which cytokines are postulated to cause anorexia?

Answer 13

IL-6 and TNF-a

Question 14

What are Fried’s 5 criteria for frailty?

Answer 14

Unintentional weight loss
Weakness
Exhaustion
Slow walking speed
Low physical activity

Question 15

How many of Fried’s criteria must be fulfilled to be assessed as pre-frail? Frail?

Answer 15

1-2 for pre-frail

≥3 for frail

Question 16

What does ADL stand for?

Answer 16

Activities of daily living

Question 17

Define disability

Answer 17

Physical or mental impairment limiting at least 1 major ADL

Question 18

Distinguish between a medical syndrome and a geriatric syndrome

Answer 18

A medical syndrome involves multiple phenomenologies contributing to a single specific morbid process
A geriatric syndrome involves a specific phenomenology resulting in multiple morbid processes

Question 19

What are the 5 giants of geriatric syndromes?

Answer 19

Incontinence
Immobility
Impaired balance
Impaired cognition
Iatrogenic illness